UW-Parkside: Center for Community Partnerships - Mentor Kenosha And Racine Mentor of the Month

Mentor of the Month Nomination Form

Nominated Mentor Information
Name of Mentor
Mentor Phone Number
Mentor E-mail Address
Mentoring Program Affiliation
Address of Program
City
State
ZIP
Phone number of Mentoring Program:
Nomination Submitted by
Name
Phone Number
E-mail
Program Affiliation (if applicable)
Relationship to Mentor

Please state why you feel this mentor should be Mentor of the Month. Descriptions of the mentor's length of service, impact on a mentee/protege, or other examples of being an effective mentor are all welcome.

Mentor of the Month Nomination Form

Nominated Mentor Information

Nomination Submitted by